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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2018, Vol. 12 ›› Issue (03) : 165 -169. doi: 10.3877/cma.j.issn.1674-0793.2018.03.003

所属专题： 文献；

论著

结直肠支架序贯联合腹腔镜手术在左半结肠癌伴肠梗阻中的应用
吕国恩1, 邹文书1, 梁宇通1, 陈秋连1, 谭翠1, 孔刚2,†()   
  1. 1. 529030　广东省江门市中心医院窥镜中心
    2. 529030　广东省江门市中心医院胃肠外科
  • 收稿日期:2017-09-20 出版日期:2018-06-01
  • 通信作者: 孔刚

Application of sequential combination of colorectal stents and laparoscopy in left colon cancer with intestinal obstruction

Guo’en Lyu1, Wenshu Zou1, Yutong Liang1, Qiulian Chen1, Cui Tan1, Gang Kong2,†()   

  1. 1. Endoscopy Center, Jiangmen Central Hospital, Jiangmen 529030, China
    2. Department of Gastrointestinal Surgery, Jiangmen Central Hospital, Jiangmen 529030, China
  • Received:2017-09-20 Published:2018-06-01
  • Corresponding author: Gang Kong
  • About author:
    Corresponding author: Kong Gang, Email:
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引用本文：

吕国恩, 邹文书, 梁宇通, 陈秋连, 谭翠, 孔刚. 结直肠支架序贯联合腹腔镜手术在左半结肠癌伴肠梗阻中的应用[J]. 中华普通外科学文献(电子版), 2018, 12(03): 165-169.

Guo’en Lyu, Wenshu Zou, Yutong Liang, Qiulian Chen, Cui Tan, Gang Kong. Application of sequential combination of colorectal stents and laparoscopy in left colon cancer with intestinal obstruction[J]. Chinese Archives of General Surgery(Electronic Edition), 2018, 12(03): 165-169.

目的

探讨结直肠支架联合腹腔镜根治手术治疗左半结肠癌伴肠梗阻患者的临床有效性及安全性。

方法

回顾性分析2012年1月至2016年12月江门市中心医院收治的可根治性切除左半结肠癌伴肠梗阻患者90例，根据治疗方式不同分为联合治疗组（33例，先行肠道支架置入术后行腹腔镜下一期切除吻合术）和单纯手术组（57例，行急诊开腹手术）。对比分析两组患者的临床成功率、安全性和疗效。

结果

联合治疗组中3例导丝无法通过狭窄处而放置肠道支架失败，未出现支架置入相关的穿孔、支架移位、出血及术后肠穿孔，技术成功率及临床成功率均为90.9%（30/33）。30例术后3~5 d均顺利施行腹腔镜下肿瘤根治术而不需施行预防性肠道造瘘术。联合治疗组以及单纯手术组的平均手术时间分别为（274.6±58.4）min、（294.3±54.2）min，两组比较差异无统计学意义（t=1.569，P=0.120）。联合治疗组术中出血量为（35.4±20.4）ml，明显低于单纯手术组的（135.5±26.9）ml，差异有统计学意义（t=17.84，P<0.001）。两组患者均未发生围手术期死亡，总体并发症、感染性并发症、非感染性并发症发生率均差异无统计学意义。

结论

结直肠支架在左半结肠癌伴肠梗阻中的应用安全、有效。结直肠支架可作为腹腔镜根治手术术前准备的"桥梁"，并发症发生率低，避免预防性肠道造口，临床短期疗效相近。

关键词: 结肠肿瘤, 肠梗阻, 支架, 腹腔镜
Objective

To explore the clinical efficacy and safety of colorectal stents combined with laparoscopic radical surgery for left colon cancer with intestinal obstruction.

Methods

A retrospective analysis of ninety patients with radical resection of left colon cancer with intestinal obstruction from January 2012 to December 2016 in Jiangmen Central Hospital was carried out. Patients were divided into two groups according to the treatment method: combined treatment group (33 cases, received early enteric stent implantational sequence with first-stage laparocopic resection and anastomosis) and simple operation group (57 cases, underwent emergency operation). Clinical success rates, safety, and surgical outcomes were compared between two groups.

Results

In the combined treatment group, 3 cases failed to place the stent through the stenosis. No patient had stent implantation related perforation, stent displacement, bleeding or postoperative intestinal perforation. The technical success rate and clinical success rate were both 90.9% (30/33). Laparoscopic radical resection was performed in 30 cases 3-5 d after stenting without prophylactic intestinal stoma. The average operation time of the combined treatment group and the simple operation group was (274.6±58.4) min and (294.3±54.2) min, with no statistically significant difference (t=1.569, P=0.120). The amount of bleeding in the combined treatment group was significantly lower than that of the simple operation group [(35.4±20.4) ml vs (135.5±26.9) ml, t=17.84, P<0.001]. No patient died during the perioperative period. There were no significant differences in overall complications, infectious complications, and non-infectious complications between the two groups.

Conclusion

As a pre-operative "bridge" for laparoscopic radical surgery, the application of colorectal stents in left colon cancer with intestinal obstruction is safe and effective, with acceptable complication rate, similar clinical short-term outcome, and preventive enterostomy is avoided.

Key words: Colonic neoplasms, Intestinal obstruction, Stents, Laparoscopes
表1 两组左半结肠癌伴肠梗阻患者的一般资料比较
组别 例数 年龄（岁，±s） 性别[例(%)] BMI（kg/m2，±s） 狭窄长度（cm，±s）
男 女
联合治疗组 33 56.7±6.2 22(66.7) 11(33.3) 21.9±3.2 2.5±0.6
单纯手术组 57 59.1±8.1 29(50.9) 28(49.1) 21.0±2.7 2.7±0.8
统计值 t=1.470 χ2=2.122 t=1.423 t=1.246
P值 0.145 0.145 0.158 0.216
组别 肿瘤部位[例(%)] 大体类型[例(%)]
降结肠 乙状结肠 直肠上段 溃疡型 肿块型 浸润型
联合治疗组 9(27.3) 16(48.5) 8(24.2) 7(21.2) 4(12.1) 22(66.7)
单纯手术组 10(17.5) 31(54.4) 16(28.1) 14(24.6) 5(8.8) 38(66.7)
χ2值 1.191 0.335
P值 0.551 0.846
图1 内镜下金属支架置入术治疗结肠癌伴肠梗阻的具体关键步骤　A为乙状结肠癌伴结肠阻梗；B为在导丝的导引下置入支架；C为释放结肠支架；D为术后X线片了解支架位置
表2 两组左半结肠癌伴肠梗阻患者术后并发症比较[例(%)，χ2检验]
项目 联合治疗组(33例) 单纯手术组(57例) χ2值 P值
总体并发症 4(13.3) 14(24.6) 1.510 0.219
感染性并发症 3(10.0) 11(19.3) 1.259 0.262
吻合口瘘 1(3.3) 8(14.0) 2.427 0.119
腹腔感染 1(3.3) 3(5.3) 0.167 0.683
切口感染 0(0) 5(8.8) 2.792 0.095
肺部感染 0(0) 2(3.5) 1.077 0.299
深静脉穿刺管感染 2(6.7) 3(5.3) 0.071 0.789
非感染性并发症 1(3.3) 6(10.5) 1.375 0.241
切口脂肪液化 0(0) 3(5.3) 1.659 0.201
下肢深静脉血栓形成 0(0) 1(1.8) 0.532 0.466
吻合口出血 1(3.3) 3(5.3) 0.167 0.683
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